Ernstbrunner Lukas, Francis-Pester Fraser W, Waltenspül Manuel, Ackland David C, Wieser Karl
Department of Orthopaedic Surgery, Box Hill Hospital, Eastern Health, Box Hill, Victoria 3128, Australia.
Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia.
Orthop J Sports Med. 2025 Aug 7;13(8):23259671251356265. doi: 10.1177/23259671251356265. eCollection 2025 Aug.
There are concerns that the Latarjet procedure for subcritical glenoid bone loss results in significant graft resorption and increased complications.
To (1) analyze the long-term results of the primary open Latarjet procedure in patients with subcritical preoperative glenoid bone loss and (2) find whether graft resorption influences these results.
Case series, Level of evidence, 4.
A total of 50 shoulders (n = 48 patients) underwent the primary open Latarjet procedure at a mean age of 27 years (range, 19-37 years) for recurrent anterior shoulder instability with subcritical glenoid bone loss (<15%). After a mean of 8.5 years (range, 6-13 years), signs of recurrent instability, shoulder function, and patient-reported outcome measures-including the West Ontario Shoulder Instability Index (WOSI); the American Shoulder and Elbow Surgeon (ASES) score; the subjective shoulder value (SSV)-were assessed. Computed tomography-morphometric analysis of graft resorption was conducted to define the pattern and volume of resorption, and its influence on clinical outcomes.
At the final follow-up, a significant increase in the SSV (65% to 84%; < .001), with a relative WOSI score of 19% ± 17% and an ASES score of 91 ± 9, was observed. One shoulder (2%) sustained a recurrent traumatic shoulder dislocation after 6.75 years but did not require revision surgery. Five shoulders (10%) experienced a subluxation, and 6 shoulders (12%) had positive anterior apprehension. Significant ( < .001) graft resorption (mean, 24% of the total graft volume) was observed at the long-term follow-up, although no patient underwent revision surgery. Resorption was concentrated in the superior segment of the graft (75%; < .001). Overall, graft resorption had no significant influence on any clinical outcome measure-including complications, pain, or signs of postoperative instability ( > .05).
The primary open Latarjet procedure for subcritical glenoid bone loss (<15%) results in an excellent clinical outcome. Although significant graft resorption (ie, concentrated around the superior screw) can be expected at the long-term follow-up, it does not result in adverse clinical outcomes, with complication and recurrence rates comparable to results of the Latarjet procedure for larger glenoid bone loss.
对于针对临界以下肩胛盂骨丢失的Latarjet手术，人们担心会导致显著的移植物吸收并增加并发症。
（1）分析初次开放性Latarjet手术治疗术前临界以下肩胛盂骨丢失患者的长期结果；（2）确定移植物吸收是否会影响这些结果。
病例系列，证据等级为4级。
共有50例肩部（n = 48例患者）因复发性肩关节前脱位合并临界以下肩胛盂骨丢失（<15%）接受了初次开放性Latarjet手术，平均年龄为27岁（范围19 - 37岁）。平均随访8.5年（范围6 - 13年）后，评估复发性不稳定的体征、肩部功能以及患者报告的结局指标，包括西安大略肩关节不稳定指数（WOSI）、美国肩肘外科医师（ASES）评分、主观肩关节价值（SSV）。通过计算机断层扫描形态计量分析移植物吸收情况，以确定吸收的模式和体积及其对临床结局的影响。
在末次随访时，观察到SSV显著增加（从65%增至84%；P <.001），相对WOSI评分为19%±17%，ASES评分为91±9。1例肩部（2%）在6.75年后发生复发性创伤性肩关节脱位，但无需翻修手术。5例肩部（10%）出现半脱位，6例肩部（12%）存在前向恐惧试验阳性。在长期随访中观察到显著的（P <.001）移植物吸收（平均占移植物总体积的24%），尽管没有患者接受翻修手术。吸收集中在移植物的上段（75%；P <.001）。总体而言，移植物吸收对任何临床结局指标，包括并发症、疼痛或术后不稳定体征均无显著影响（P >.05）。
针对临界以下肩胛盂骨丢失（<15%）的初次开放性Latarjet手术可取得优异的临床效果。尽管在长期随访中可预期有显著的移植物吸收（即集中在上部螺钉周围），但这不会导致不良临床结局，其并发症和复发率与针对更大肩胛盂骨丢失的Latarjet手术结果相当。
